JAC Advance Access originally published online on October 16, 2003
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Journal of Antimicrobial Chemotherapy (2003) 52, 842-848
© 2003 The British Society for Antimicrobial Chemotherapy
Outcomes of an intervention to improve hospital antibiotic prescribing: interrupted time series with segmented regression analysis
1 MEMO (Medicines Monitoring Unit), Department of Clinical Pharmacology, University of Dundee, Dundee DD1 9SY; Departments of 2 Pharmacy, 3 Infectious Diseases and 4 Medical Microbiology, Ninewells Hospital, Dundee; 5 Department of Epidemiology and Public Health, University of Dundee, Dundee; 6 Health Services Research Unit, University of Aberdeen, Aberdeen, UK
Received 18 June 2003; returned 7 August 2003; revised 27 August 2003; accepted 28 August 2003
Objectives: To evaluate an intervention to reduce inappropriate use of key antibiotics with interrupted time series analysis.
Methods: The intervention is a policy for appropriate use of Alert Antibiotics (carbapenems, glycopeptides, amphotericin, ciprofloxacin, linezolid, piperacillin–tazobactam and third-generation cephalosporins) implemented through concurrent, patient-specific feedback by clinical pharmacists. Statistical significance and effect size were calculated by segmented regression analysis of interrupted time series of drug use and cost for 2 years before and after the intervention started.
Results: Use of Alert Antibiotics increased before the intervention started but decreased steadily for 2 years thereafter. The changes in slope of the time series were 0.27 defined daily doses/100 bed-days per month (95% CI 0.19–0.34) and £1908 per month (95% CI £1238–£2578). The cost of development, dissemination and implementation of the intervention (£20 133) was well below the most conservative estimate of the reduction in cost (£133 296), which is the lower 95% CI of effect size assuming that cost would not have continued to increase without the intervention. However, if use had continued to increase, the difference between predicted and actual cost of Alert Antibiotics was £572 448 (95% CI £435 696–£709 176) over the 24 months after the intervention started.
Conclusions: Segmented regression analysis of pharmacy stock data is a simple, practical and robust method for measuring the impact of interventions to change prescribing. The Alert Antibiotic Monitoring intervention was associated with significant decreases in total use and cost in the 2 years after the programme was implemented. In our hospital, the value of the data far exceeded the cost of processing and analysis.
Keywords: education, professional behaviour change, quality improvement
* Corresponding author. Tel: +44-1382-632575; Fax: +44-1382-642637; E-mail: peter{at}memo.dundee.ac.uk
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